Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 26, 2018; 6(16): 1206-1209
Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1206
Posaconazole-associated severe hyperbilirubinemia in acute myeloid leukemia following chemotherapy: A case report
Zai-Wei Song, Yu-Chen Pan, Zhen-Cheng Huang, Wen-Xi Liu, Rong-Sheng Zhao, Hong-Mei Jing, Fei Dong
Zai-Wei Song, Zhen-Cheng Huang, Wen-Xi Liu, Rong-Sheng Zhao, Department of Pharmacy, Peking University Third Hospital, Beijing 100191, China
Yu-Chen Pan, Hong-Mei Jing, Fei Dong, Department of Hematology, Peking University Third Hospital, Beijing 100191, China
Author contributions: Dong F conceived the report of the case; Song ZW, Pan YC and Huang ZC prepared the first draft of the manuscript together; Liu WX and Zhao RS revised the protocol; Jing HM and Dong F examined and approved the manuscript; all authors critically reviewed and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient and his family before all procedures described in the report as well as for the use of the patient’s clinical information for publication.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Fei Dong, MD, Doctor, Department of Hematology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191, China. knowflying@163.com
Telephone: +86-10-82266784
Received: September 18, 2018
Peer-review started: September 18, 2018
First decision: October 12, 2018
Revised: November 20, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Processing time: 97 Days and 14.2 Hours
Abstract
BACKGROUND

Posaconazole is a widely used azole antifungal agent, and posaconazole-associated severe hyperbilirubinemia is usually rare in clinical practice. We herein report a 58-year-old male with acute myeloid leukemia, who developed fungal infection following chemotherapy.

CASE SUMMARY

After administration of posaconazole oral suspension, the patient developed severe hyperbilirubinemia and jaundice (Common Terminology Criteria for Adverse Events, CTCAE -Grade 3) with a serum total bilirubin (T-BIL) peak level of 170 μmol/L, alkaline phosphatase level of 739 U/L, alanine aminotransferase level of 99 U/L, and gamma-glutamyl transpeptidase level of 638 U/L. After posaconazole withdrawal and symptomatic treatment with liver-protective agents, the level of T-BIL and other laboratory data decreased gradually, and related symptoms disappeared. After medication analysis and literature review, we consider that the patient had a cholestatic type of posaconazole-induced liver injury, which was related to intracellular mitochondrial DNA damage. The case demonstrates that when patients with hematological malignancy develop severe infection following chemotherapy, combination of anti-infective drugs may contribute to a higher risk of severe drug-induced liver injury.

CONCLUSION

This is the first thoroughly documented case report of posaconazole-associated severe hyperbilirubinemia. Therefore, in order to avoid severe adverse events, liver and renal function should be monitored closely before and during the administration of posaconazole.

Keywords: Posaconazole; Hyperbilirubinemia; Liver injury; Acute myeloid leukemia; Case report

Core tip: Posaconazole is safe and tolerable in most cases and posaconazole-associated severe hyperbilirubinemia is usually very rare. For patients with hematological malignancy who develop severe infection following chemotherapy, combination of anti-infective drugs may contribute to higher risk of posaconazole-induced severe liver injury of cholestatic type. Therefore, for patients with hematological malignancy, liver and renal function should be monitored closely before and during the administration of posaconazole.